From CFO to CEO: How to Make the Leap

David Cauble reflects on his journey as a long-time healthcare CFO to becoming the new CEO at Sky Lakes Medical Center, and how other CFOs can make a leadership transition.

Editor's note: This is part two of an interview with David Cauble, who discusses the top issues facing healthcare CEOs in 2022, finding solutions to those challenges, and the opportunities for CFOs to become CEOs. Read part one here.

Many healthcare CFOs aspire to an advanced role and wonder whether they have the right stuff to be an organization's CEO. After four stints as CFO, David Cauble decided that he certainly did, and he set his sights on the top leadership role.

Cauble was recently appointed CEO at Sky Lakes Medical Center, a 176-bed teaching hospital in Klamath Falls, Oregon. He says his lengthy experience as a CFO was excellent training ground for the center's top spot.

HealthLeaders recently spoke to Cauble about his journey to the new CEO role, what he sees as the greatest challenges facing healthcare CEOs this year, and his advice on how other CFOs can successfully make a leadership transition.

HealthLeaders: What do you think are the top issues facing hospital and healthcare systems in 2022?

David Cauble: Perhaps the most immediate issue facing hospitals and healthcare systems is staffing.  The pandemic has disrupted the workforce in a variety of ways, and it will take some time before we find the right path to recovery. 

Staff turnover, wage increases, staff burnout, illness, and many other factors have changed how organizations staff and manage the operating needs of their health systems. The economic impact of higher wages and the cost of turnover are contributing to the negative margins at many hospitals. This is forcing leaders to reevaluate staffing needs and models of care.

Recruiting and retention of medical staff is of particular concern. Many physicians are considering early retirement and leaving the profession, or they looking for a change in how they practice medicine. The pandemic has made the situation worse, but the topic of physician burnout and retention was a growing concern well before COVID.

This issue is of special concern to a rural healthcare system. At those hospitals and care facilities, the loss of key providers can significantly impact access to care and the ability to deliver clinical services safely and efficiently.

In the case where a critical service is lost, the hospital obviously suffers the economic impact. But the community is also left with inadequate medical care. That directly impacts the health and well-being of the population and further increases the cost of care to the patients as they must travel and incur higher personal cost to meet their clinical needs.

HealthLeaders: How are these challenges affecting your organization and other healthcare systems in rural areas such as yours?

Cauble: Unfortunately, it is not possible to answer this question without acknowledging the financial pressures that many hospitals face. The difficulties of rural healthcare systems are well documented, as numerous hospitals are closing and communities face the uncertainty of life without adequate access to medical care.

The pandemic has highlighted many of the healthcare disparities that exist across the country. The economic toll of the past two years has resulted in additional hospital closures and significant realignment of services in other large systems.

Increased cost, coupled with decreasing reimbursement, adds to the complexity of the challenge that health systems face. The movement from volume to value holds some potential, and as a community provider we are focusing more on the health and well-being of our community.

The necessary transformation to create a sustainable health enterprise is slow in coming but it is the right direction, and I am confident that we will navigate this difficulty journey. 

The solutions to these issues and many more are not easy, and they will require focused effort and commitment to a transformational vision. Each community will have different challenges and different priorities that will significantly influence the solutions offered. Improving the health and well-being of populations will require local engagement. As a rural health system CEO, I am focused on strengthening our commitment to the community and developing partnerships to make a difference for those we serve. 

HealthLeaders: Based on your personal experience, do you think the transition to a CEO role is possible for many CFOs?

Cauble: I believe experience as a CFO provides a strong background for the individual who aspires to the CEO role. 

Unfortunately, many hospital boards are reluctant to select a CFO candidate because they see the CFO as strictly a financial leader. But the role of the CFO has evolved into a strategic leadership position that involves much more than a traditional understanding of finance and accounting.

I would encourage CFOs looking to move into a CEO role to consider smaller hospitals and systems that serve rural areas. Similarly, I would encourage boards to broaden their search criteria to include well-qualified CFOs in the mix as well.

HealthLeaders: What advice do you have for healthcare CFOs that aspire to a CEO role?

Cauble: Seek mentors who will invest in your development and help prepare you for a CEO opportunity. 

Many of the CFO-to-CEO opportunities are promotion opportunities within an existing organization. As more CEOs and boards begin to think about succession planning, [CFOs should] not be afraid to have a conversation with the CEO about development opportunities.

Seek out 'stretch assignments' that will increase experience and demonstrate competencies in the areas that are important to boards.  Ask how you can become a part of the succession process; expressing your interest may spark great discussions and provide you with valuable feedback on how you are viewed by others. 

Passively waiting to be asked seldom works, so take the initiative and engage in the process.